Zusammenfassung:
This report estimated the utilization of outpatient benefits of the Philippine Health Insurance Corporation and examined variations across local governments. We analyzed utilization patterns by key socio-demographic and economic characteristics to better understand healthcare inequalities. The findings reveal several key insights. First, outpatient utilization rates exhibit significant geographic variation, with disparities reaching up to fivefold, indicating persistent inequities in access to care. Second, about 70% of outpatient claims are attributed to kidney-related conditions, largely driven by the rapid expansion of hemodialysis benefits in recent years. Third, in the case of Konsulta, the comprehensive primary care benefit package under the UHC Law has only registered about a quarter of the population, and fewer than 2% have been profiled through a First Patient Encounter (FPE). Our results highlight critical inefficiencies and inequities in the delivery of outpatient services and the need for policy reforms to strengthen outpatient and primary healthcare to improve overall health system performance.